This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Friday, 19 October 2007

Fighting Back and Losing: But NOT GIVING UP

1. Staff nurses at my hospital are so distraught over the poor ratios, the rotten nursing care, and the burn out of staff that they are staying over at the end of their shifts unpaid to fill incident reports re: near misses and errors. They mention the poor staffing levels and their direct effect on patient in most of these reports. They have been doing this for years but it has accelerated in the last several months.

Response from Management: Completely ignored.

2. Staff Nurses have requested meetings with the powers that be to talk to them and explain what is going on and how dangerous it all is to the patients and nurses themselves. Have requested that some of these guys spend a shift shadowing a nurse to get a feel for how crazy it all is down there on the floors. Have requested that they look into research regarding Nurse patient ratios and how shitty ratios run hospitals into the ground and really fucks patients and their nurses up.

Response from Management: Completely Ignored.

3. Nurse Managers throughout the hospital get together and send a letter to the powers that be trying to reason with them and explain what is happening to nurses and patients as a result of their refusal to hire and staff the wards. These are the nurse managers who help out on the floor.

Response from Management: Completely Ignored.

4. Apparently Consultants have come together (ages ago) and written to the bosses because the staffing on the wards is even scaring the shit out of them.

Response from managers: Nothing.

Goodness me even a "we understand your position and are trying to think of ways to improve the situation" would be greatly appreciated. Throw us a bone for christs sake.

5. Five Staff nurses (3 on my ward) have left to take lower paid jobs outside of health care. This has been over the last few months alone. I have lost count of the ones before that. Three have obtained teaching assistant jobs. Two have headed for the supermarkets. These nurses hold degrees in nursing and invested a lot of time an energy into their education and their work. They say they'll come back when things improve. I would do the same thing. I would happily take a pay cut to get out but I will be applying for a nursing job in another country in the next year or two and want recent experience on my CV. I may get out anyway to protect my nursing license if things don't improve.

Response from Management: Nothing.

But they are talking about compulsory redundancies which will cause them to get grief from unions so they are more than happy to see registered nurses quit. It's more of a "don't let the door hit your arse on the way out mentality" and "thanks for making our job that much easier by leaving voluntarily".

Nice.

Have written to the press, asking them to look into what is going on with the recruitment freeze, the appalling ratios, and the effect this has on nursing care. Have been ignored so far. It is more fun to write pieces that describe nurses as uncaring if she can't feed 20 people at the same time by herself while managing acutely ill patients by herself. Oh yeah give me 2 HCA's so they can each feed ten patients by themselves while answering call bells that are constantly ringing. Problem solved. Not. What we need is cloning technology or a course in how to astroproject.

Any suggestions about how to fight back? Have already been down the NMC and Union route many times.

Edited to Add: Just found this article about some American Nurses who have been fired for whistleblowing about unsafe ratios. They are fighting back and trying to get the message out. Maybe we should go door to door.

Have you considred the RCN advice line? I know that that may seem at first a bit of a pointless thing to do, but at least it can try to add some meat to the bones of your argument. I have dealt with such a system before and believe you me, all you ever get is the big fob off.

I would ask all nures on your ward to keep a diary of the dates and times, and also record the interval of time passing between correspondance. I hate to say, but the first point (staying behind) is a card I once played while making a complaint of my old job, this was met with the simple statement of "Any work which is done by a member of staff in their own time which results from their own compulsion is the act of, and responsability of the individual. If there were significant concern's, this should have been communicated during office hours". Tossers, the lot of them.

I would also play the student's facing needless unemployement card (Such as myself). Keep up the fight though, and keep on trying!

Take another look at Dr Pals recent item [Dr Rants site], and the BMJ link providing sage advice on the dangers of "whitleblowing" [and measures to best protect yourself if you have the courage to go down this road].

I'm sure you've already considered the MP/Press route but both options are fraught with danger.

What would be the easiest for the Trusts managers to deal with it;[1] Correction of widespread institutional failings presumably in a climate of financial cut backs, or.

[2] Marginalising/discrediting a nurse agitator ?

I would have suggested getting one or two conultants on board as well but juging by recent posts it seems the MDT is just as dysfunctional as other aspects of the hospital ?

The words lamb and sacrificial come to mind - I would hate to think of patients being deprived of somebody with your skills, knowledge and caring attitude ;o)

I understand what you are saying Charge Nurse and your are right I would go to the slaughter. I bet you that other staff would deny what I was saying to fall in favour with the managers. People are afraid and want to keep their jobs above all else. Even having this blog scares me.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.